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The Journal of Bone and Joint Surgery 81:1501 (1999)
© 1999 The Journal of Bone and Joint Surgery, Inc.

Correspondence

Correspondence

Dennis J. Callahan, M.D., Kevin B. Freedman, M.D. and Joseph Bernstein, M.D., M.S.

TO THE EDITOR:

I commend Freedman and Bernstein for addressing a very important issue in their study "The Adequacy of Medical School Education in Musculoskeletal Medicine" (80-A: 1421–1427, Oct. 1998). However, I believe that the real issue is not how well first-year orthopaedic residents were able to answer questions chosen by chairpersons of orthopaedic residency programs but rather how primary-care physicians can address the second most common patient complaint, musculoskeletal symptoms. The authors documented the importance of this education, but their testing was not aimed at the appropriate population. I suggest that the authors design an examination based on questions from chairpersons of family practice, pediatric, and internal medicine residency programs or, better yet, based on an actual sampling of musculoskeletal symptoms encountered by primary-care physicians from various locations. This examination should then be given to first-year primary-care residents.

I believe that the results of this type of study would be even more informative. Such a study is sorely needed to document the poor musculoskeletal education in medical school. Primary-care doctors need to know how to perform a basic musculoskeletal examination and to be able to determine which problems they are able to treat and which problems need to be referred. They do not need to know which type of fracture of the femur is treated with replacement and which is treated with a plate and screws, which muscles are involved in tennis elbow, or which muscles control external rotation of the humerus. If they would just know the names of the bones, we would be farther ahead than we are now.

Dennis J. Callahan, M.D.: 800 East 28th Street, Suite 307, Int Zip 39307, Minneapolis, Minnesota 55407

Dr. Freedman and Dr. Bernstein reply:

We thank Dr. Callahan for his interest. We agree that generalists, not orthopaedists, are the ideal population to study. Of the eighty-five recent graduates from medical school who were tested for our investigation, only seven were planning a career in orthopaedic surgery.

We also agree that merely teaching generalists the names of the bones would be a step in the right direction. When one receives a call about an isolated "fibia [sic] fracture," it does not inspire confidence that the rest of the (supposedly normal) examination was performed expertly.

Kevin B. Freedman, M.D.; Joseph Bernstein, M.D., M.S.: Department of Orthopaedic Surgery, 424 Stemmler Hall, University of Pennsylvania, Philadelphia, Pennsylvania 19104–6081


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